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The Branch Manager, Date

IDBI Bank Limited, D D M M Y Y Y Y
Please open my sole/our joint/sole proprietorship Fixed Deposit (FD) Floating rate (Please Select)
account at your branch

Title First Name Middle Name Surname
1st applicant
2nd applicant
3rd applicant
Guardians Name (In case applicant is minor)
Relationship with minor Father Mother By court order (if yes please affix a copy) Others (Please Specify)

1st applicant 2nd applicant 3rd applicant

Date of Birth (dd/mm/yy)

Gender Male Female Third Gender Male Female Third Gender Male Female Third Gender

Mothers maiden surname

Marital status
Relationship with
first applicant

Mobile No.

Office Phone No.

Email ID

Existing Customer ID
*please fill form 60 in case of non-availability of pan/gir number
Firm name (for sole proprietorship)
Correspondence Address
Bldg./Road Name
Area City
Landmark (near/opposite) State Pin code
Country Phone(res): Fax no.

Permanent Address Same as above

Bldg./Road Name
Area City
Landmark (near/opposite) State Pin code
Country Phone(res): Fax no.

Introduction by existing IDBI Bank account holder and Document confirming mailing address in name of applicant

Cust ID Account No.

I confirm that I am an account holder with IDBI Bank for over six months. I confirm that I personally know the applicant/s detailed herein for years and confirm
his/her identity and address.

Signature of introducer Signature verified (for bank use)

Self introduction Signature & EIN No.
Amount Cash Transfer from a/c no.
Cheque no. dated drawn on bank,
branch (All Cheques for initial payment amount, will be drawn in favour of IDBI Bank Ltd. - Customer Name)
Simple Reinvestment Period Others (please specify)
Fixed Interest Rate : Annual Quarterly Monthly Discounted At Maturity (Cumulative)
Floating Interest Rate : Quarterly Payout At Maturity

Senior Citizens : No Yes (please attach proof)

Overdraft Against FD Account (minimum amount of FD is 10,000, available only on deposit of tenure 6 months and above)

For TDS (please tick as applicable): No tax to be deducted at source - PAN/GIR No. OR
No tax to be deducted- Form 15G/15H enclosed

Auto renew* principal By credit to my bank account no.

Auto renew* principal & interest Auto renew for period :
year(s) month(s) day(s) By Payorder / Demand Draft
Auto renew* `

Pay principal & interest Pay principal SMS Alerts: Hindi English
*Renewal will be done at the then prevailing interest rate

Sweep in Savings Account

in case of insufficient balance in my savings account no. please clear my cheque/allow withdrawal by
transferring funds to my savings account by breaking units of my/our fixed deposits.
Minor Account
I shall represent the minor in all future transactions of any description in the above account till the said minor attains majority. I shall fully indemnify the bank against any claim of
the above minor for any withdrawal/transaction made by me in his/her acount.
Sole Proprietorship Account
I/We refer to the account opened by you in the name of
and declare as under, I the undersigned, am the sole proprietor of the firm and solely responsible for liabilities thereof. I shall advice you in writing of any change that may take place
in the constitution of the firm and i will be liable to you for any obligation which may be standing in the firms name in your books on the date of the receipt of such notice and until
all such obligations shall have been liquidated.
yours faithfully,
Name Signature

(please sign without the stamp)


Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in respect of bank deposits.
(Name) (Name)
Address Address

Nominate the following person to whom in the event of my/our/minors death, the amount of deposit in the account(s), particulars whereof are given below, may
be returned by IDBI Bank Limited branch.
Nature of Deposit Account No. Additional details, if any

Mailing Address

City State PIN Code

Relationship with depositor (if any) : Age (yrs):
Nominee Guardian (if nominee is minor): Father Mother Court Appointed Guardian Court Receiver Defacto Guard Others
Date of Birth (if nominee is minor)

*As the nominee is a minor on this date, I/We appoint Shri/Smt./Kum.

Mailing Address

City State PIN Code

Country ,to receive the amount of the deposit in the account on behalf of the nominee in the event of my/our/
minors death during the minority of the nominee.
I do not wish to avail nomination facility

1st Applicant Signature 2nd Applicant Signature 3rd Applicant Signature


Name Name

Signature *** Signature ***

Address Address

Place Place
Date Date
* Strike out if nominee is not a minor. ** Where the deposit is made in the name of minor, the nomination should be signed by a person lawfully entitled to
act on behalf of the minor. *** Thumb impression(s) shall be attested by two witnesses.
Registration No. (To be filled in by the bank)


Single Either or survivor* Former or survivor* Anyone or survivor* Jointly by all Others (please specify)
We jointly agree and authorize IDBI Bank Ltd to, pay the principal along with interest and permit premature withdrawals of the fixed deposit on
written instruction from any one of us, any day before the maturity date.

1st Applicant 2nd Applicant 3rd Applicant

Signature Signature Signature

Application/ guardian should also sign across photographs as well as space provided for signature.


Residential status Resident Non resident

Occupation Service Retired Self employed Housewife Others (Please specify)

If in service Name of organization

If self employed-nature of business Trading Manufacturing Services Agriculture Real estate Other (Please specify)
Since when in business specify Year Since (Year)
If self employed professional CA Doctor Lawyer Stock broker Consultant Others (Please specify)

Sources of Income Salary Business Agriculture Others (Please specify)

Annual Income (Pl attach copy of
latest IT return / form16 / salary slip)
Transaction profile i.e. value of transactions likely to be routed through the account in a month/ quarter/half year. In case of new firm sales tax return of the
previous quarter or projected sales may be accepted. :
< ` 50,000 < ` 1,00,000 > ` 10 lakh > ` 100 lakh
Details of branch offices/allied associate concerns and nature of their business :
Details of foreign collaboration if any.
Residence Owned Leased Others (Please specify)

Marital Status Married Single



We acknowledge your Nomination Form DA1 relating to:
Nature of Account Account Number Additional Details, if any

In the name of__________________________________________________held with us. Please quote the Nomination Number__________________
in all your future correspondence with us in this regard.
For IDBI Bank Limited Authorised Signatory
Name of Spouse - Mr / Mrs:
Date of birth of spouse: Marriage anniversary :
Other dates important to me: 1. Occasion
2. Occasion
Mother Tongue: D D M M Y Y Y Y

Details of children :
1. Name:
Male Female Third Gender Age: Resident / Non-resident Married / Single
2. Name:

Male Female Third Gender Age: Resident / Non-resident Married / Single

3. Name:

Male Female Third Gender Age: Resident / Non-resident Married / Single

Office address:
City: Pin: Type of organisation: Public Ltd. Private Ltd. Public Sector Proprietary Partnership
I like : Travelling Vacationing Reading Partying Sports/Games Eating out Yoga/Meditation Shopping Performing Arts
Photography Collection Fine Arts Others
The Vehicle I drive:
My favourite cuisine: Home cooked food Indian Chinese Thai French Italian Mexican
My preferred vacation site: Hills Coastal Wild life trip Cruise Religious trip Health resorts Family home
My preferred music: Vocal India Pop Remix Ghazals Western Traditional Religious Instrumental Others _________
Books/Newspapers I read: Language in which I prefer to read
Preferred topics: Fiction History Personalities Inspirational Literature Others
No. of times I travel in a year: Within India Abroad
My favourite airline: Within India Abroad I normally travel for Business Leisure Both


Academic Qualification: Graduate Post Graduate Professional Other
University / College last attended Batch



Risk Level ( Customer Profile): Low Risk (Level 1) R L Medium Risk (Level 2) R L High Risk (Level 3) R L
We have complied with all the requirements of the KYC and AML policy, KYC & AML Master Circular of the Bank updated till now.
We have complied with all requirements, Circulars/instructions issued by the Bank till date with regard to the proposed Product.
All Statutory, Regulatory and Internal Guidelines issued up-to-date have been complied with regard to this AOF.
I here by certify that all the necessary KYC documents have been obtained/verified by me. I confirm that the documents are adequate to comply with KYC requirement of the Bank.
I hereby confirm that I have verified UN list of terrorist groups & GOI advices & banks guidelines & confirm the applicant/s are not included in caution advices/black list. Based on
this account may be opened.
Name of the Branch Head/Acting Branch Head
Date Employee Code Branch: CIN - L65190MH2004GOI148838

DST code:1 Lable Code:1

DST code:2 Lable Code:2
Scheme Code Signature
Cust. ID 1
Name of Vertical
Cust. ID 2
A/c No.
Cust. ID 3

IDBI Bank Limited, Regd. Office: IDBI Tower, WTC Complex, Cuffe Parade, Mumbai 400 005.
Toll Free Numbers reachable from any landline/Mobile phones: 1800-200-1947/ 1800-22-1070, Non- Toll Free Number: 022-66937000.

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